Antifungals - Topical: Nursing pharmacology

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Notes

TOPICAL ANTIFUNGALS
DRUG NAME
nystatin (Nystop), tavaborole (Kerydin), ciclopirox (Loprox), ketoconazole (Extina), miconazole (Fungold), 
econazole (Ecoza), efinaconazole (Jublia)
CLASS
Topical antifungals
MECHANISM OF ACTION
Disrupting and damaging the fungal cell membrane → fungistatic or fungicidal action
INDICATIONS
Cutaneous fungal infections (skin, hair, nail)
ROUTE(S) OF ADMINISTRATION
TOP
SIDE EFFECTS
  • Skin rash
  • Itching
  • Burning
  • Stevens-Johnson syndrome
CONTRAINDICATIONS AND CAUTIONS
None
NURSING CONSIDERATIONS
Assessment and monitoring
  • Assess the affected area
    • Moist, red patches, papules, pustules, discharge
    • Itching, burning, pain
    • Laboratory results: skin scrapings
  • Monitor for side effects
  • Assess understanding of medication self-administration
  • Evaluate therapeutic effect

Client education
  • Purpose of medication: treat fungal skin infection
  • Self-administration
    • Wash hands before and after application
    • Clean the area with mild soap and water
    • Gently pat dry with a clean towel
    • Apply antifungal cream in a thin layer, exactly as directed
  • Topical use only; not for oral, ophthalmic, or vaginal use
  • Report skin irritation, burning, or painful rash that worsens; if infection does not resolve
Author: Maria Emfietzoglou, MD
Illustrator: Robyn Hughes, MScBMC

Transcript

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Topical antifungals are medications used to treat cutaneous fungal infections, which are conditions that affect the skin, hair, and nails, and can be caused by a variety of fungi, such as Candida albicans or dermatophytes.

The most commonly used topical antifungals include nystatin, tavaborole, ciclopirox, and azoles like ketoconazole, miconazole, econazole, and efinaconazole. These medications are applied topically on the affected skin, in the form of ointments, creams, gels, or foams.

Once administered, topical antifungals work by disrupting and damaging the fungal cell membranes, ultimately resulting in a fungistatic action, meaning that they stop fungal growth, or a fungicidal action, meaning they kill the fungi.

As far as side effects go, topical administration of antifungals can cause the development of a skin rash, as well as itching, and burning of the skin area.

Additionally, some clients may present with serious hypersensitivity reactions, such as Stevens-Johnson syndrome. Fortunately, there are no major contraindications for the use of topical antifungals.

Alright, when caring for a client that is prescribed a topical antifungal medication like ketoconazole, first assess the affected skin area, making note of the presence of moist, red patches, papules, pustules, and discharge, as well as itching, burning, and pain. Then, review recent laboratory test results, including results from skin scrapings.

Next, be sure to teach your client how the prescribed medication can help treat their cutaneous fungal infection. Remind them that the medication is for topical use only, and not for ophthalmic, oral, or vaginal use.

Summary

Topical antifungals are medications that are applied directly to the skin or nails to treat fungal infections. They work by killing or stopping the growth of fungi that cause infections.

Topical antifungal medications are available in various forms, including creams, lotions, gels, sprays, and powders. Commonly used topical antifungals include nystatin, tavaborole, ciclopirox, and azoles like ketoconazole, miconazole, econazole, and efinaconazole.

Topical antifungal medications are used to treat different skin infections including tinea corporis, tinea pedis, and pityriasis versicolor.Topical antifungals are generally safe and well-tolerated, and side effects are uncommon. However, some people may experience mild to moderate side effects, including skin irritation, allergic reactions, and discoloration of skin, hair or nails.

Sources

  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology: A patient-centered nursing process approach (8e)" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2021)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2020)
  5. "Goodman & Gilman's: The Pharmacological Basis of Therapeutics (13e)" McGraw-Hill Education (2018)